Acute conjunctivitis has been the sole sign and symptom of COVID-19 in a small number of patients, according to researchers who say atypical clinical presentations demonstrate why health professionals should exercise a high level of suspicion.
The European study conducted by ophthalmology academics highlighted five patients who developed non-remitting conjunctivitis, but had no fever malaise or respiratory symptoms throughout the course of their illness.
Each patient – four males and one female aged 37 to 65 – tested positive for COVID-19 and fully recovered, with acute conjunctivitis remaining as the only form of disease manifestation.
Each patient was questioned about recent travels or close contacts with a positive case. All revealed they recently travelled to the Lombardy region in Italy, which had high numbers of COVID-19 cases.
The work was published in the journal Science Direct by the Department of Medical and Surgical Sciences within the University of Bologna in Italy.
Co-authors Assistant Professor Sergio Zaccaria Scalinci, an ophthalmologist, and Dr Edoardo Trovato Battagliola, conducting his ophthalmology residency, said they wanted to emphasise that atypical clinical presentations of COVID-19 can occur and a high level of suspicion should be maintained.
“Ocular involvement and transmission of SARS-CoV-2 should never be overlooked. In fact, conjunctival mucosae are susceptible to respiratory viruses and remain an important point of entry,” they said.
“For this reason, eye protection in the form of goggles or a face shield should be considered essential for all healthcare providers, even when taking care of patients who are not showing typical symptoms of COVID-19.”
The American Academy of Ophthalmology highlighted the study on its website this month.
Limitations included the fact there was no in-depth evaluation of the patients such as genetic analysis to determine why they did not subsequently develop more commonly associated symptoms of fever, general malaise or respiratory symptoms.
In addition, it is unknown if the subjects previously had a mild case of undetected COVID-19 and had antibodies to COVID-19 upon presentation with the conjunctivitis.